Patients deemed to be at the highest risk of developing type 2 diabetes should be offered a place on an intensive lifestyle change programme, according to latest guidance.
The National Institute for Health and Care Excellence has today published an updated version of its guidance for preventing type 2 diabetes in adults. The guideline was first published in 2012 and last reviewed in 2014.
“Helping someone make simple changes to diet and exercise levels can significantly reduce their risk”
In its new 2017 update, NICE said the 1.7 million people who have the highest risk of developing type 2 diabetes should be offered a place on an intensive lifestyle change programme.
It highlighted lifestyle change programmes, such as the Healthier You: NHS Diabetes Prevention Programme developed by NHS England and Public Health England, which aim to reduce the prevalence of diabetes by helping people to change their diet and increase their physical activity.
NICE said it was cost effective to offer lifestyle support to people with a fasting glucose between 5.5–6.9 mmol/l, but that prioritisation could be given to people with a higher reading (6.5-6.9mmol/l) due to their increased risk of developing type 2 diabetes.
Part of the guideline dealing with the use of the drug metformin has also been updated regarding its use to support lifestyle change.
The guidance already called on clinicians to use their “clinical judgement” about offering metformin to those whose HbA1c or fasting plasma glucose results had deteriorated, despite participation in intensive lifestyle-change programmes or were unable to participate in such a programme.
The updated version adds that this should particularly be the case if the patient cannot participate and has a body mass index greater than 35.
NICE said the lifestyle programmes should be designed to help as many people as possible and should be accessible to those with mental illness or dementia who may have poorer physical health.
It also identified specific groups that should be encouraged to see their GP or community pharmacy for a diabetes risk assessment and then offered advice to help them delay or prevent the condition.
The groups identified include all adults aged 40 and above, except pregnant women, and those aged 25-39 and of South Asian, Chinese, African-Caribbean or Black African descent.
A third group picked out by NICE for risk assessment was adults with conditions that increase the risk of type 2 diabetes, such as obesity, stroke or high blood pressure.
However, NICE also noted that its guidance aimed to remind practitioners that “age is no barrier to being at high risk of, or developing, the condition”.
Professor Mark Baker, director of the centre for guidelines at NICE, said: “We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing type 2 diabetes.
“And that this approach is a cost-effective way of managing an illness that currently costs the NHS around £8.8bn a year,” noted Professor Baker.
“We need to make sure that the people most at risk have access to the care they need,” he said. “This is why this updated guidance from NICE is so important, it will help NHS England and Public Health England to prioritise when necessary.”